An evidence-based approach to the use of rotational and directional coronary atherectomy in the era of drug-eluting stents: when does it make sense?
Advances in percutaneous interventions have profoundly changed the way we manage patients with coronary and peripheral arterial disease. Though the use of stents, particularly drug-eluting stents, is the preferred method for revascularization because of ease of use and lower restenosis rates, there are many short comings. Ostial and bifurcation lesions as well as heavily calcified and tortuous arteries remain problematic. Mechanical debulking with rotational and direct coronary atherectomy may be beneficial in these situations. In this review, we present the general concepts of mechanical debulking and attempt to summarize the available data on its use in the setting of drug-eluting stents. In addition, we will discuss its special role in the management of peripheral arterial disease.
Tran
Trung
T
Division of Cardiology, Washington University Medical School, St. Louis, Missouri 63110-1093, USA.
Brown
Michael
M
Lasala
John
J
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000295:instrumentation; D002114:Calcinosis / Q000628:therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D054059:Coronary Occlusion / Q000628:therapy; D023903:Coronary Restenosis / Q000209:etiology; D054855:Drug-Eluting Stents; D004867:Equipment Design; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D018570:Risk Assessment; D016896:Treatment Outcome